Healthcare Provider Details

I. General information

NPI: 1255690384
Provider Name (Legal Business Name): HOPE ALLIANCE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 LOWRY AVE NE APT 201
MINNEAPOLIS MN
55418-1912
US

IV. Provider business mailing address

951 LOWRY AVE NE APT 201
MINNEAPOLIS MN
55418-1912
US

V. Phone/Fax

Practice location:
  • Phone: 206-883-0990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FARDOWSA A MOHAMED
Title or Position: CEO
Credential:
Phone: 206-883-0990